Arthroscopic treatment of chronic osteochondral lesions of the talus - Long-term results
Arthroscopic treatment of chronic osteochondral lesions of the talus - Long-term results
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DOI：
10.1177/0363546508316773
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发表时间：
2008-09-01
影响因子：
4.8
通讯作者：
Dopirak, Ryan M.
中科院分区：
文献类型：
--
作者：
Ferkel, Richard D.;Zanotti, Robert M.;Dopirak, Ryan M.
背景资料：骨软骨病变的距骨是相对罕见的，但可能是一个原因，显着的疼痛和残疾症状patients.Hypothesis：关节镜下治疗骨软骨病变的距骨将导致良好的长期临床结局在大多数patients.Study设计：病例系列;证据等级，4.方法：50例慢性骨软骨病变的距骨进行了关节镜下治疗。平均年龄为32岁（范围：12-72岁）。平均随访71个月（范围：24-152个月）。治疗包括对距骨骨软骨病变进行原位钻孔（n = 4）、切除距骨骨软骨病变并进行磨损关节成形术（n = 6）或切除距骨软骨病变并钻孔（n = 40）。对距骨骨软骨病变进行术前和术中分期。随访评价采用亚历山大、改良Weber、American Orthopathy Foot and Ankle Society踝/后足评分3种临床评分系统。结果：亚历山大评分优/良72%，可20%，差8%。根据改良的Weber量表，64%的结果为优/良，30%为一般，6%为差。美国矫形足和踝关节协会踝关节/后足评分平均为84（范围：34-100）。我们发现平片、计算机断层扫描或磁共振成像分期与临床结果之间无相关性。然而，关节镜分期与临床结果之间存在显著相关性。17例患者已被视为5年前，并使用相同的标准进行评估; 35%表现出恶化，随着时间的推移，他们的结果。结论：关节镜下治疗的慢性症状性骨软骨病病变的距骨结果在大多数患者的良好的临床效果。然而，疼痛和功能限制可能在某些患者中持续存在，特别是那些在关节镜检查时发现有不稳定骨软骨缺损的患者。
Background: Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients.Hypothesis: Arthroscopic treatment of osteochondral lesions of the talus will result in good long-term clinical outcomes in the majority of patients.Study Design: Case series; Level of evidence, 4.Methods: Fifty patients with chronic osteochondral lesions of the talus underwent arthroscopic treatment. Average age was 32 years (range, 12-72 years). Average follow-up was 71 months (range, 24-152 months). Treatment consisted of either drilling of the osteochondral lesions of the talus in situ (n = 4), excision of the osteochondral lesions of the talus and abrasion arthroplasty (n = 6), or excision of the osteochondral lesions of the talus and drilling (n = 40). Preoperative and intraoperative staging of the osteochondral lesions of the talus was performed. Follow-up evaluation included 3 clinical rating systems: Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society Ankle/Hindfoot scores.Results: There were 72% excellent/good, 20% fair, and 8% poor results on the Alexander scale. According to the modified Weber scale, there were 64% excellent/good, 30% fair, and 6% poor results. The average American Orthopaedic Foot and Ankle Society Ankle/Hindfoot score was 84 (range, 34-100). We found no correlation between plain radiographs, computed tomography, or magnetic resonance imaging staging and clinical results. However, there was significant correlation between arthroscopic stage and clinical outcome. Seventeen patients had been seen 5 years previously and evaluated using the same criteria; 35% demonstrated a deterioration in their result over time.Conclusion: Arthroscopic treatment of chronic symptomatic osteochondral lesions of the talus results in good clinical outcomes in the majority of patients. However, pain and functional limitation may persist in some patients, especially those noted to have unstable osteochondral defects at the time of arthroscopy.